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SEWAGE <br /> Distance to Public Sewers ----•--•— Connection necessary: Yes No_ <br /> ! Does existing septic system comply with Ord. #549 : Yeses No_ <br /> Unknown If no, explain: <br /> P <br /> Describe septic "installat�on to be installed: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well: Yesc>1_1 No Is well proper: <br /> Yes-2L No State deficiency: <br /> Does existing or porposed use make this well public water: Yes <br /> No Sample of well water taken: Yea No`s Date taken <br /> Renu isAdditional ,information or comments <br /> 3 , GARBAGE & ,REELISE <br /> Licensed scavenger pick--up: Yes No Service Area No. <br /> Other �I oposed disposal method: <br /> Potential-problem: ---- - --- <br /> 4 . ELY, MOSQUITO OR V M PO'S'E TTAT, <br /> State possible vector ptnti\ 1 necessary control : <br /> 5 . TOILETLBATH4FACILITES �. <br /> No. & location existing: �__- Additional <br /> facilities needed <br /> 6 . PREVIOUS_ OPERATION HIETQRY 1 <br /> 7 GENERAL,,.a 111 A='���� - <br /> State any problems not previously noted: <br /> f <br /> 8 . POULaIQU DEREITY <br /> Appx'. No. People per sq. mi . <br />